Production of Vegetables and Artichokes Is Associated with Lower Cardiovascular Mortality: An Ecological Study

Alberto Arnedo-Pena, Joan Puig-Barberà, Juan Bellido-Blasco, MªAngeles Romeu-Garcia, Rosario Pac-Sa Mª and Francisco Guillen-Grima
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Alberto Arnedo-Pena: Health Sciences Department, Public University Navarra, 31008 Pamplona, Spain
Joan Puig-Barberà: Vaccines Research Area FISABIO, 46020 Valencia, Spain
Juan Bellido-Blasco: Epidemiology Division Public Health Center, 12003 Castello de la Plana, Spain
MªAngeles Romeu-Garcia: Epidemiology Division Public Health Center, 12003 Castello de la Plana, Spain
Rosario Pac-Sa Mª: Epidemiology Division Public Health Center, 12003 Castello de la Plana, Spain
Francisco Guillen-Grima: Health Sciences Department, Public University Navarra, 31008 Pamplona, Spain

IJERPH, 2020, vol. 17, issue 18, 1-16

Abstract: Mortality due to cardiovascular disease (CVD), including cerebrovascular disease (CED) and ischaemic heart disease (IHD), was considerably different in eight municipalities of the province of Castellón, Community of Valencia (Spain) during the period of 1991–2011. In addition, these villages showed differences in agricultural practices and production. Since high vegetable consumption has been linked to decreased all-cause, CVD, and CED mortalities, we hypothesized that the diversity in vegetable and artichoke production, used as proxies for their consumption, could be associated with the diversity of mortality rates. In order to test our hypothesis, we estimated the smoothed standardized mortality ratios (SMRs) of CVD, CED, and IHD mortalities and a directed, age-adjusted mortality rate (AMR). We used a multilevel linear regression analysis to account for the ecological nature of our study. After adjustment, the CVD and CED SMRs were inversely associated with vegetable and artichoke production, with a reduction in SMRs for CVD: −0.19 (95% Confidence Interval [CI] −0.31 to −0.07) and −0.42 (95% CI −0.70 to −0.15) per hectare/10 3 inhabitants, respectively. The SMRs for CED also decreased: −0.68 (95% CI −1.61 to −0.19) and −1.47 (95% CI −2.57 to −0.36) per hectare/10 3 inhabitants, respectively. The SMRs for IHD were not associated with vegetal and artichoke production. When the directed AMR was used, CED mortality was consistent with the previous results, whereas the CVD mortality association was lost. Our results indicate that vegetable and artichoke production may act as protective factors of CED and CVD mortalities.

Keywords: mortality; cardiovascular; cerebrovascular; vegetables; artichokes; agriculture; municipalities; multilevel; ecology (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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